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Government Report Supports Lifting Ban on Federal Funding for Needle Exchange


November 1995

A report by a government-commissioned panel recommends lifting the ban on federal funds for needle exchange programs (Warren Leary, "Report Endorses Needle Exchanges as AIDS Strategy," New York Times, September 20, 1995, p. A1; John Schwartz, "Report Backs Funding for Needle Exchanges," Washington Post, September 20, 1995, p. A3; George Judson, "Study Finds AIDS Risk to Addicts Drops If Sale of Syringes Legal," New York Times, August 30, 1995, p. A1).

The 319-page report examines existing needle exchange programs and previous studies about the effect of needle exchange on the spread of AIDS. It finds that needle exchange programs do slow the transmission of HIV and do not encourage drug use. The report also recommends lifting the ban on federal funding for bleach needle sterilization programs, although it found clean needle exchange more effective in HIV prevention.

The review was conducted by the Institute of Medicine and the National Research Council, a Congressionally-directed private policy study organization, and was overseen by the National Academy of Sciences.

Department of Health and Human Services Assistant Secretary Philip Lee said the Clinton administration will review the report, but cautioned that Congress has expressed that it opposes funding for needle exchanges. He called needle exchange "an extraordinarily complex public policy strategy."

The report did not recommend establishment of a nationwide needle exchange program, recognizing that the spread of AIDS in drug-using communities varies by geographic region. It recommends that local needs be determined according to problems in that area and the feelings of community members toward controversial policy options like needle exchange.

In 1992 legislation, Congress provided that the ban on needle exchange funding can be lifted if the Surgeon General "determines that such programs are effective in preventing the spread of HIV and do not encourage the use of illegal drugs." Because the position of Surgeon General is vacant, it is unclear if another Clinton administration official could act on the recommendations of the report.

75 needle exchange programs operate in 55 cities. A number of recent reports by the American Medical Association, the General Accounting Office, and the Centers for Disease Control and Prevention have supported lifting the needle exchange ban and have advocated abolition of state drug paraphernalia laws barring possession of syringes (see "Drug Policy Foundation Releases Secret Internal Administration Reports on Needle Exchange," NewsBriefs, March 1995).

In a related development, studies published in the Journal of Acquired Immune Deficiency Syndromes found that needle sharing fell by 40% after Connecticut laws were changed to allow nonprescription sales of hypodermic needles.

The five least restrictive states allow the sale of syringes in pharmacies and do not have paraphernalia laws against possession: Connecticut, North Dakota, Alaska, Iowa, and South Carolina. The District of Columbia and nine states, including those with the worst IV drug problems, require a prescription for purchase and possession of syringes: California, New York, New Jersey, Illinois, Pennsylvania, Massachusetts, New Hampshire, Rhode Island, and Delaware.

The new Connecticut law allows pharmacies the option of selling syringes, but does not require it. Nonprescription sales are limited to 10 per purchase. Less than one year after the law, 83% of pharmacies had started selling syringes, and 10% reported problems associated with the sales.

Another study in the journal found that the percentage of addicts wo reported sharing needles in the past month fell from 52% to 30% after the ban was lifted. Although it was a common belief that addicts shared needles as a kind of bonding ritual, interviews with addicts revealed that most only shared needles out of necessity. Most addicts favored the use of a clean needle every time, and some reported keeping an extra clean needle on hand in case another addict needed it.

In 1981, only 12% of new AIDS cases were IV drug users, while that percentage has grown to 28% in 1993. An unpublished report by the Centers for Disease Control estimated that in 1994, three-quarters of all new AIDS cases were tied to drug use, including IV drug users, crack users, and women who have sex with men who inject drugs (see "CDC Report Finds Spread of AIDS Epidemic Increasingly Tied to Drug Addiction, Prompts Examination of Current AIDS Prevention Policies," NewsBriefs, March 1995).

[To obtain a copy of the report "Preventing HIV Transmission: The Role of Sterile Needles and Bleach," contact the National Academy Press at 2101 Constitution Avenue, NW, Box 285, Washington, DC 20055, 202-334-3313, 800-624-6242. The report costs $37.95 plus $4.00 shipping and handling.]